The Board of Supervisors on Wednesday August 12, approved a plan to create a single county health agency to integrate the operations of the public health, mental health and health services departments. Proponents said the move would integrate the delivery of healthcare and streamline access to services, while opponents said it would create more bureaucracy and further stigmatize mental illness. Supervisor Michael Antonovich recommended the consolidation, calling it a “business imperative.”

“It will reform the treatment and care,” Antonovich said, pointing to a single system for tracking medical records and economies of scale in purchasing drugs as two big improvements. Many healthcare advocates told the board there was little correlation between integrating services and consolidating departments.

“Integrated care does not happen at the administrative level, it happens at the service level,” Cassandra Loch of the Los Angeles County Coalition for an Office of Health­care Enhancement told the board.

The coalition, which represents 135 organizations and agencies representing those with mental illness and substance abuse problems, called for a collaborative model holding the leadership of all three health departments equally accountable. But others pointed to a lack of coordination between departments as evidence that more dramatic change is required, telling stories of patients being bounced from one place to another while trying to access care. The new model would maintain three separate departments with separate budgets but a lead agency would drive integration.

Supervisor Sheila Kuehl said “there’s a lot of fear” about what will go wrong, with very little discussion of “what we will gain” or “how screwed up it is now.” She described the current system as “quite dysfunctional.”

Bob Schoonover, president of the Service Workers International Union Local 721, told the board that union members were “greatly supportive” because “they want to provide the best services possible in the fastest, most efficient way. ... I don’t think many people would design a healthcare system like this from scratch.”

A single agency model is not expected to lead to layoffs or budget cuts, according to interim Chief Executive Officer Sachi Hamai. Many doctors and nurses said integrating the three departments will give them the ability to more easily refer patients to the right specialists and sharing medical records and lab results will lead to better outcomes.

“How can we provide quality care if we can’t see the whole system?” asked one nurse.

However, dozens of mental health advocates argued that consolidating services would send a message to patients and providers that mental health treatment was not a priority. It would leave the Depart­ment of Mental Health as “one of only two county departments not reporting directly to the board,” Brittney Weissman of the Los Angeles County Council of the National Alliance on Mental Illness said. Antonovich said department heads would still have access to the board.

Other opponents said mental health care would be “medicalized” as doctors pursued a narrow, less holistic approach. Antonovich said the model would not force a “medical model that ignores the recovery-based models and social determinants of health. The opposite is true.” Still others saw the move as a power grab by Dr. Mitchell Katz who heads the county’s hospital system and is viewed as almost certain to lead a consolidated agency.

While the Department of Health Services is responsible for the county hospital system, the Department of Public Health is responsible for managing outbreaks of communicable diseases; runs programs to promote health goals such as childhood vaccination; and inspects restaurants and nursing homes. Public health and health services were run as a single county agency prior to July 2006 and some opponents of consolidation pointed to that history as evidence consolidation would not be an improvement. A spokesman for the American Cancer Society raised the example of anti-smoking campaigns, which languished under the joint agency but flourished once the Department of Public Health was given its own mandate.

The board's vote was 4-0-1 with Supervisor Don Knabe abstaining. Knabe said he wanted to wait until he saw the details of a strategic plan for the agency.

“I’m supportive of the integration but the devil’s in the details,” Knabe said.